1548483100 NPI number — LEWIS & LEWIS EYE CARE CLINIC, P. C.

Table of content: (NPI 1548483100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548483100 NPI number — LEWIS & LEWIS EYE CARE CLINIC, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS & LEWIS EYE CARE CLINIC, P. C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548483100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14975 BYPASS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHOCTAW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73020-8504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-390-9106
Provider Business Mailing Address Fax Number:
405-390-1105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14975 BYPASS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHOCTAW
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73020-8504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-390-9106
Provider Business Practice Location Address Fax Number:
405-390-1105
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
NEAL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-390-9106

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2072 AND 768 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1053311183 . This is a "TERRY LEWIS NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 456607937001 . This is a "LARRY LEWIS BLUE CROSS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100766570A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 443703087 . This is a "TERRY LEWIS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 1317550002 . This is a "PALMETTO GBA DMERC" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 1952301095 . This is a "LARRY LEWIS NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 443703087001 . This is a "TERRY LEWIS BLUE CROSS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 456607937 . This is a "LARRY LEWIS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 700522004 . This is a "MEDICARE PTAN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100763240A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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